Individual
JESSICA LEE GLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
709 CHEATHAM ST, SPRINGFIELD, TN 37172-2828
(615) 212-0082
Mailing address
709 CHEATHAM ST, SPRINGFIELD, TN 37172-2828
(615) 212-0082
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3993A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4205845
BLUE CROSS BLUE SHIELD OF TENNESSEE
TN
05
—
74000613
—
KY
Enumeration date
09/26/2005
Last updated
09/29/2021
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